Cavalié Guillaume, Boudissa Mehdi, Kerschbaumer Gaël, Seurat Olivier, Ruatti Sébastien, Tonetti Jérôme
Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire d'Anatomie des Alpes Françaises (LADAF), Faculté de médecine, Domaine de la Merci, 38700 La Tronche, France.
Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France.
Orthop Traumatol Surg Res. 2022 Jun;108(4):103288. doi: 10.1016/j.otsr.2022.103288. Epub 2022 Apr 22.
Antegrade posterior column screw fixation (APCS) provides stable fixation while reducing the complications related to dual acetabular approaches. The objective of this study was to present the radiological and clinical outcomes of fixation of the posterior column of the acetabulum through a single anterior approach.
APCS will produce better clinical and radiological outcomes relative to not placing any screws in the posterior column.
This was a retrospective single-center study of 69 patients operated through a single anterior approach for a both-column fracture of the acetabulum between 2014 and 2018. Patients were divided into two groups (APCS+, n=24 and APCS-, n=45) depending on whether the posterior column was fixed with an antegrade lag screw or not. The radiological outcomes were defined by the quality of the reduction according to Matta. The clinical outcomes were evaluated using the Harris Hip score and Merle Postel D'Aubigné (MDP) score at the final assessment. A sequential hierarchical analysis was done with a Chi test for the radiological criterion and Student's t test for the clinical outcomes.
In the APCS+ group, the reduction was anatomical in 71% (17/24) of patients, imperfect in 12% (3/24) and poor in 17% (4/24). In the APCS- group, the reduction was anatomical in 33% (15/45) of patients, imperfect in 31% (14/45) and poor in 35% (16/45). This difference between groups was statistically significant (p=.012). The differences between groups in the Harris (p=.201) and MDP (p>.05) scores were not significant. Mean irradiation in the APCS+ group was significantly higher (114.8 cGy.cm) relative to the APCS- group (39.8 cGy.cm) (p<.001). None of the patients in the APCS+ group underwent a subsequent total hip arthroplasty, while 8 patients from the APCS- group did (p=.031). The differences in the postoperative complications were not statistically significant.
APCS yields satisfactory radiological and clinical outcomes without increasing the complication rate; this must be balanced out against the additional irradiation.
III.
顺行后柱螺钉固定术（APCS）可提供稳定的固定，同时减少与双侧髋臼入路相关的并发症。本研究的目的是展示通过单一前路入路固定髋臼后柱的影像学和临床结果。
相对于后柱不置入任何螺钉，APCS将产生更好的临床和影像学结果。
这是一项回顾性单中心研究，纳入了2014年至2018年间通过单一前路入路接受双侧髋臼骨折手术的69例患者。根据后柱是否用顺行拉力螺钉固定，将患者分为两组（APCS+组，n = 24；APCS-组，n = 45）。影像学结果根据Matta的复位质量进行定义。在最终评估时，使用Harris髋关节评分和Merle Postel D'Aubigné（MDP）评分评估临床结果。对影像学标准进行卡方检验，对临床结果进行学生t检验，进行序贯分层分析。
在APCS+组中，71%（17/24）的患者复位为解剖复位，12%（3/24）为不完美复位，17%（4/24）为复位不佳。在APCS-组中，33%（15/45）的患者复位为解剖复位，31%（14/45）为不完美复位，35%（16/45）为复位不佳。两组之间的这种差异具有统计学意义（p = 0.012）。两组在Harris评分（p = 0.201）和MDP评分（p>0.05）上的差异无统计学意义。APCS+组的平均辐射剂量（114.8 cGy.cm）相对于APCS-组（39.8 cGy.cm）显著更高（p<0.001）。APCS+组中没有患者随后接受全髋关节置换术，但APCS-组中有8例患者接受了全髋关节置换术（p = 0.031）。术后并发症的差异无统计学意义。
APCS产生了令人满意的影像学和临床结果，且未增加并发症发生率；这必须与额外的辐射剂量相权衡。
III级。
